Contract Pharmacy Details

CVS STATE CAPITAL, L.L.C.
CH013280 D.F.D. RUSSELL MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

D.F.D. RUSSELL MEDICAL CENTER, INC.

Subdivision Name

DFD RUSSELL MEDICAL CENTER - LEEDS

Type

HRSA-Funded Health Center

340B ID

CH013280

Entity Address

180 Church Hill Rd
Leeds, ME 04263-3418

Grant Number

H80CS00642

Participating Start Date

1/1/2001

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

CVS STATE CAPITAL, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00620
1 KENNEDY MEMORIAL DR.
WATERVILLE, ME 04901

Pharmacy Comments

Contract Details

Approval Date

7/7/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Laurie Kane-Lewis, CEO
(207) 524-4001

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/7/2022

340B Drug Pricing Program Database